﻿@model IEnumerable<MvcMedicalProvider.Models.ProviderType>
@{
    ViewBag.Title = "Provider Cost Comparison";
    Layout = "~/Views/Shared/_Layout.cshtml";
}

<div class="title" align="center"><div style="height: 10px"></div>Provider Cost Comparison</div>
@using (Html.BeginForm("PreviewResults", "SearchProvider"))
{
    <center>
        <div style="padding: 20px 0 0 0; width: 1000px" align="center">
            <table border="0" cellpadding="0" cellspacing="0" style="font-size: 15px">
                <tbody>
                    <tr>
                        <td valign="top" align="left">
                            <div style="padding-left: 30px">
                                <form method="GET">
                                    <table border="0" cellpadding="0" cellspacing="0">
                                        <tbody>
                                            <tr>
                                                <th>&nbsp; Provider Specialty</th>
                                                <th>&nbsp; Provider ZIP Code*</th>
                                                <th>&nbsp; Radius</th>
                                            </tr>
                                            <tr>
                                                <td style="padding: 5px">
                                                    <select name="speci" style="border: 1px solid #D0D0D0">
                                                        <option value="">– ANY SPECIALTY –</option>
                                                        @foreach (var item in Model)
                                                        {
                                                            if (item.provider_type == "Family Practice")
                                                            {
                                                                <option value="@item.provider_type" selected>@item.provider_type</option>
                                                            }
                                                            else
                                                            {
                                                                <option value="@item.provider_type">@item.provider_type</option>
                                                            }
                                                        }
                                                    </select>
                                                </td>
                                                <td style="padding: 5px">
                                                    <input type="text" name="zipCode" maxlength="10" class="ctinput"
                                                           style="width: 130px; text-align: center; padding-left: 3px" value="@ViewBag.YourZipcodeLiteral"
                                                           onkeypress="return numbersOnly(event)"
                                                           id="zipCode">
                                                </td>
                                                <td>
                                                    <select name="range">
                                                        <option value="10" selected="selected"> 10 Miles Radius</option>
                                                        <option value="25"> 25 Miles Radius</option>
                                                        <option value="50"> 50 Miles Radius</option>
                                                        <option value="100"> 100 Miles Radius</option>
                                                    </select>
                                                </td>
                                            </tr>
                                            <tr>
                                                <td colspan="3" align="center" style="padding-top: 10px">
                                                    <b>Doctor</b><br>
                                                    <b>Last Name&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;First Name</b><br>
                                                    <input type="text" name="dlname" id="dlname" maxlength="20" class="ctinput" style="width: 150px; text-align: center; padding-left: 3px; color: GrayText;"
                                                           value="@ViewBag.OptionalLiteral">&nbsp;
                                                    <input type="text" name="dfname" id="dfname" maxlength="20" class="ctinput" style="width: 150px; text-align: center; padding-left: 3px; color: GrayText;"
                                                           value="@ViewBag.OptionalLiteral">
                                                </td>
                                            </tr>
                                            <tr><td colspan="3" align="center" style="padding: 0; background: none; height: 0"><br><input type="submit" onclick="submitSearchProviderForm(); return false;" value="" class="sb" valign="middle"> Compare</td></tr>
                                            <tr><td colspan="3" align="center" style="padding: 10px" valign="middle"><div id="ldimg" style="display: none"><table border="0"><tbody><tr><td valign="middle"><img src="/images/loading_32x32.gif" border="0"></td><td valign="middle"> &nbsp; Searching ...</td></tr></tbody></table></div></td></tr>
                                        </tbody>
                                    </table>
                                </form>
                                <br><br>* <i style="font-size: 12px">Zip Code of Doctor's Office</i>
                            </div>
                        </td>
                        <td style="padding: 0 0 0 20px" align="left" valign="top"></td>
                    </tr>
                </tbody>
            </table>
        </div>
    </center>
}